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Globally, maternal mortality rates have been declining over the past several years. In America, however, the maternal death rate more than doubled between 1987 and 2013. In fact, though the United States is one of the most developed countries in the world, it’s the second to last among 31 developed countries, ahead of only Mexico, according to the Organization for Economic Cooperation and Development. And, according to a recent report in the Los Angeles Times, black women are dying at the highest rates.

More from the Los Angeles Times:

The maternal death rate in Texas after 2010 reached “levels not seen in other U.S. states,” according to a report compiled for the American College of Obstetricians and Gynecologists, based on figures from the U.S. Centers for Disease Control and Prevention.

Black women in Texas are dying at the highest rates of all. A 2016 joint report by the Texas Department of State Health Services’ Maternal Mortality and Morbidity Task Force found that black mothers accounted for 11.4% of Texas births in 2011 and 2012, but 28.8% of pregnancy-related deaths.

Researches and doctors can’t pinpoint a single cause for the distressingly high mortality rate among black women, but the L.A. Times has put forth some theories: “persistent poverty, large numbers of women without adequate health insurance, risk factors related to stress and discrimination.”

Due to anti-abortion legislators, Texas has seen steep cuts in programs that offer women’s healthcare, and has the largest percentage of uninsured women of any state in the country. “In an ideal world, a woman would have the opportunity to have a visit with a physician before she becomes pregnant to identify any potential risk factors before she gets pregnant,” said Dr. Lisa Hollier, an OB/GYN who heads the Maternal Mortality and Morbidity Task Force. “Then a woman would enter prenatal in her first trimester. Unfortunately, African American women are the least likely to have that first trimester of prenatal care.”

Another issue black women face is persistent discrimination, which may result in medical professionals taking their care less seriously. Houston Rep. Shawn Thierry, who has introduced legislation requiring a study on the social and economic factors that may influence the high maternal mortality rate among black mothers, told the L.A. Times, “We know there are instances where [African American mothers] are not given the proper level of attention and care because of assumptions that doctors and hospitals are making about them.”

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Read the rest of the L.A. Times report here.